With small bleeding (internal or latent), they resort to puncture (joint, pleural cavity, pericardium). Endoscopic and radiological examinations are of great help in the diagnosis. Widespread: bronchoscopy, thoracoscopy, esophagoscopy, gastroscopy, duodenoscopy, sigmoidoscopy, colonoscopy, laparoscopy, cystoscopy.
To study internal bleeding, the radioisotope method can be used. The radionuclide is administered intravenously and normally accumulates in the liver, where it is absorbed by the reticuloendothelial cells and disappears from the bloodstream after 15-20 minutes. In pathology, it, together with poured blood, is found in tissues or in the cavity.
With hidden bleeding in the gastrointestinal tract, a benzidine test is used.
Outcomes of bleeding: bleeding leading to a rapid decrease in maximum blood pressure to 80 mm Hg. Art. or a drop in the percentage of hemoglobin by 1/3 of the initial values, it is extremely dangerous, since bleeding of the brain may develop. During a slow, for several weeks, blood loss, the body adapts to chronic anemia and can exist for a long time with a very low hemoglobin content.
Blood poured into a closed cavity can squeeze the brain, heart, lung, etc., disrupt their activity and create a direct threat to life. Hemorrhages, squeezing the vessels that feed the tissues, sometimes lead to the necrosis of the limb.
The blood circulating in the vessel is largely bactericidal, while spilling into the tissue and cavity, it becomes a good breeding ground for microbes. Therefore, with internal or interstitial accumulations of blood, there is always a chance of infection. So, the development of pyogenic microflora with hemothorax causes purulent pleurisy, with hemarthrosis - purulent arthritis.
Without medical assistance, bleeding can result in spontaneous stopping or bleeding and death from anemia of the brain and impaired cardiovascular activity.
Spontaneous stop of bleeding. It occurs as a result of a spasm of a blood vessel and the formation of a blood clot in its lumen, which contributes to a decrease in blood pressure during bleeding.
If then a purulent infection does not develop in the cavity (pleural, abdominal, etc.), then the blood is destroyed and absorbed. With intracapital hematoma on the extremities as a result of the closure of a damaged vessel by a thrombus, blood circulation is usually restored through collateral vessels, and the hematoma can gradually dissolve. Due to reactive inflammation, a connective tissue capsule is often formed around the accumulation of blood, i.e. a blood cyst appears. Usually scars and commissures appear around it, and calcium salts are deposited in the capsule itself.
Blood loss compensation mechanisms: for the outcome of bleeding, the magnitude and speed of blood loss, the age of the patient, the general condition of the body and the cardiovascular system are of great importance.
To maintain the necessary level of blood supply to vital organs in the body, a complex adaptation mechanism develops, including: 1) vasospasm; 2) increased heart rate and respiration; 3) an increase in the volume of circulating blood by attracting it from the depot and tissue fluid.
Profuse (massive) arterial bleeding leads to acute anemia so quickly that blood loss compensation mechanisms do not have time to develop. And even a mild bleeding is the cause of the death of the patient. The main work to restore blood loss falls on the cardiovascular system. Therefore, in old age, when the heart and blood vessels no longer have sufficient reserves, worse outcomes are observed. Sclerosis, organic defects and functional disorders of cardiac activity are very unfavorable moments. Blood loss is poorly tolerated by young children, since they have not yet had time to form all the compensation mechanisms. An important role is played by the biochemical properties of blood, in particular, the state of the coagulation system. If it is violated, for example, streets suffering from hemophilia, even a slight wound can lead to acute anemia and death of the victim.
Methods for temporarily stopping bleeding: raise the limb, bend as much as possible in the joint and squeeze the vessels passing in this area (finger pressure, pressure bandage, application of a tourniquet, as well as clamps on a bleeding vessel in the wound). Existing methods have positive and negative sides and are used in isolation or in combination (for example, pressure dressing and elevated limb position). Any injury to the limb without clear signs of damage to a large artery serves as an indication for the application of a pressure bandage. Its disadvantage is that it does not stop the bleeding from large arteries and, squeezing the tissue, leads to circulatory disorders in the peripheral parts of the limbs. By raising the limb high, bleeding can be stopped if the veins are damaged. This method is often used in combination with a pressure dressing.
Artery constriction. It is used to temporarily stop arterial bleeding on the limbs, neck, head. The pressing is performed above the bleeding place, where there is no large muscle mass, where the artery does not lie very deep and can be pressed down to the bone. Pressing is performed at specific points. The most important of them: inguinal fold - for the femoral artery, popliteal region - for the lower leg artery, elbow joint
- for the brachial artery in the elbow, the axillary region and the inner surface of the biceps muscle - for the artery of the hand; on the neck at the inner edge of the sternoclavicular muscle, near its middle - for the carotid artery, pressing it with a finger to the transverse process of the VI cervical vertebra. The subclavian artery is squeezed, pressing it to 1 rib at a point located above the collarbone, immediately outward from the point of attachment of the sternocleidomastoid muscle to the hilt of the sternum. The axillary (axillary) artery can be squeezed by pressing it to the head of the humerus in the armpit. The brachial artery is pressed against the inner surface of the humerus at the inner edge of the biceps. The femoral artery is most easily squeezed by pressing it against the horizontal branch of the pubic bone at a point located immediately below the pupartic ligament (in the inguinal region) in the middle of the distance between the anterior superior iliac axis and the symphysis (the intermaxilla).
By squeezing the vessel with a finger, it is sometimes possible to temporarily stop the bleeding and deliver the victim to the surgical department. Often, when the vessel is pressed with a finger, the large nerve trunks located nearby are also compressed, which causes severe pain. Prolonged arrest of bleeding with this method is not possible.
Applying a tourniquet. Circular tugging of the soft tissues of the limb together with blood vessels is carried out by a tourniquet. There are various modifications (tourniquet with a pilot, elastic, etc.). Esmarch’s harness is a sturdy rubber tube up to 1.5 m long, with a metal chain attached to one end and a hook to the other. A rubber bandage less injures tissue than a rubber tube.
The uplifted limb is surrounded by a strongly stretched tourniquet 2-3 times above the site of damage, after which it is tied or hooked to a chain. In order not to pinch the skin, put a towel under the tourniquet. When the tourniquet is correctly applied, arterial bleeding stops immediately, the pulse disappears and the limb turns pale (waxy appearance). Excessively tight pulling can cause paralysis and necrosis of the limb. A loosely applied tourniquet compresses only the veins, which leads to stagnation of blood in the limbs and increased bleeding. When injuring only veins, a tourniquet is usually not required, since bleeding can be stopped by applying a pressure bandage, raising the limb and improving the outflow.
Disadvantages of applying a tourniquet: 1. Compression of not only arteries, but also nerve trunks, which can lead to paresis. 2. The cessation of blood circulation in the tissues reduces their resistance to infection and creates favorable soil for the development of anaerobic gangrene; 3. The tourniquet should not be left on the limbs for more than 2 hours due to the danger of necrosis. Therefore, the accompanying patient should be advised of the time of application of the tourniquet.
To reduce the adverse effect, it is recommended that after one hour, the tourniquet be dissolved for several minutes (if bleeding does not resume) and then tightened again. This improves the nutrition of tissues and increases their resistance, which is especially important when transporting victims in the cold season (especially in winter).
It is not recommended to apply a tourniquet to the limbs with acute surgical infection, or with vascular damage (arteriosclerosis, thrombophlebitis, etc.), as this can contribute to the spread of the process or the development of embolism.
In addition to the arterial tourniquet, the so-called venous tourniquet is sometimes applied for bleeding from large subcutaneous veins. It is superimposed below the site of damage to the vessel with a force that causes compression of only superficial veins, and for up to 6 hours.
Use such a tourniquet for other purposes (deposition of blood in the extremities during bloodletting, etc.)
Twist (hauling). In the absence of a specialized tow, you can use improvised material, for example, a scarf.
It is tied at first completely freely, then some stick or board is inserted into the loop and the scarf is twisted to the required degree.
Methods of the final stop of bleeding are divided into four groups:
1) mechanical, 2) thermal, 3) chemical and 4) biological. With extensive wounds and severe bleeding, it may be necessary to apply several methods simultaneously or sequentially in various combinations. Along with this, measures are taken to combat acute anemia (transfusion of blood or blood substitute solutions, intravenous administration of glucose solutions, isotonic sodium chloride solution, etc.). Often, to stop internal bleeding, they resort to surgery (gluttony, thoracotomy, craniotomy, etc.).